Organization
PHOENIX HOUSES OF LOS ANGELES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ELIZABETH SALAZAR MPH (REGIONAL CLINICAL DIRECTOR)
(818) 686-3015
Entity
Organization
Contact information
Practice address
11465 KAGEL CANYON ST, LAKE VIEW TERRACE, CA 91342-6505
(818) 686-3000
Mailing address
11600 ELDRIDGE AVE, LAKE VIEW TERRACE, CA 91342-6506
(818) 686-3000
Taxonomy
Speciality
Code
Description
License number
State
3245S0500X
Children's Substance Abuse Rehabilitation Facility
Primary
190115DN
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1945
MEDICAL
CA
Enumeration date
06/25/2013
Last updated
12/02/2013
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